Monday, May 10, 2010

Doctors Are Woefully Unprepared for Business

Never has there been a better example of the failure of cardiac electrophysiology training programs to teach the business of medicine to our fellows than this story of a cardiac electrophysiologist from Tennessee who opened his own practice, only to be later evicted when he couldn't pay his rent:

Evaluation and management billing codes will never support electrophysiologists in such a setting, since the majority of a cardiac electrophysiologist's revenue is generated from procedural volume. Payments from Medicare (our primary patient population) comes in two forms for care delivered to patients: (1) professional and (2)technical. Technical revenue provided from Medicare for our procedures is ten times the professional payment paid to doctors.

Hospitals know this, hence why I'm employed by one. Procedually-based doctors should know this before opening their own practices.

I don't think that an MBA is a prerequisite to being able to successfully run a small business (though I'm sure it can't hurt). That idea is an unfortunate fiction; getting experience by working in a group is one way of making sure you know what you're getting into. Another is to start looking into small business issues earlier on. You don't need the degree to be a competent entrepreneur.

Even if medical schools don't have the time to teach the basics of business management to interested students, it doesn't take much to help those students identify the things they need to learn on their own.

My DH is lucky - I've been an entrepreneur since age 15, so when we married, he got my business smarts to compliment his clinical smarts. When it comes to business, he's clueless, but he's an excellent physician. He knows this and says it often that in medical school they simply ignore the business of medicine, leaving graduates ill prepared if they're not interested in academia or group practice.

I totally agree with Notwithstanding - one certainly doesn't need a degree to do well in business....but, it definitely helps to have some idea of what you need to keep in mind when you're trying to do your numbers if you have no experience in business.

For example, DH knows he is reimbursed X-dollars for Y-visit-type, but he doesn't know how much it costs him to do Y-visit. That's what I do - I determine his overhead for Y-visit, which, from a business perspective is everything from soup to nuts - the time the receptionist spent taking the appointment, the paper used in the chart, the SF of the exam room and its cost per minute, the average time for both DH and a nurse in the room, to the time needed to say goodbye by reception and take co-payment...then time and energy needed to bill insurance.

Amazingly, some of DH's well reimbursed visit types were actually losing money due to the overhead that isn't obvious! It's not like he can stop doing them, they're part of his specialty, but at least he now KNOWS the cost of doing business per visit type or procedure type.

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.